Navigation: My Journey, My Growth, My Identity

I have been an oncology nurse for 39 years, and my journey has been long and fruitful. The word “navigation” was not a part of my language at the start of my career, but as I look back, I have come to understand that every experience along my nursing journey was preparing me to serve as an oncology nurse navigator.

My journey started as most nurses in the mid 1980s as a staff RN, but on a dedicated in-patient oncology unit. After a few years, I became “the person” to speak with patients/families about their journey after a diagnosis and what they needed to know to get through the experience. Hmm…sounds like navigation.

After a few years, I became “the person” to speak with patients/ families about their journey after a diagnosis and what they needed to know to get through the experience. Hmm…sounds like navigation.

Next step was as a dedicated staff and patient educator. Continuing in the same vein, I helped to educate staff on anticipated needs of the patients/families going through treatment for a cancer diagnosis, as well as direct interventions throughout their journey. Hmm…sounds like navigation.

Next move, bone marrow/stem cell nurse/educator. Even more dedicated time to the patient/family in preparation for the experience and plan of care development to meet immediate and long-term needs before, during, and after a bone marrow/stem cell transplantation, as well as integration/merging of work-life balance, school, and emotional support. Next, I moved to Hospital Education, with the responsibility for developing standardized systemwide cancer education for nurses and other patient/caregiver resources as needed (noted growth from “family to caregiver”). Hmm…sounds like navigation.

I eventually moved to the role of nurse manager of a 32-bed dedicated in-patient oncology unit. Responsibilities moved to managing resources and staff mixture to make sure patients/caregivers had essential resources required during active treatment, supportive physical and emotional care, and discharge planning. While not as much direct patient/caregiver contact, assuring the right staff mix (nurses, case managers, social workers, pharmacy, chaplain, etc) to coordinate needed care services and discharge planning was essential to the role. Hmm…sounds like navigation.

After retiring, my general conversation was that I was still trying to “figure out what I wanted to be when I grew up.” My journey led me to in-patient hospice care and nursing consultant, which ultimately led to greater involvement in public health. This exposed me to a greater degree of understanding the needs for cancer prevention, screening, and survivorship after a cancer diagnosis. Watching my professional growth continuing even after retirement was exciting. Hmm…looks like navigation.

But ultimately, I missed direct patient/caregiver contact. During this time, I also had several close family members go through a cancer experience (breast, prostate, lymphoma, and acute leukemia) and other major health events (CVA, CHF, MS). I finally found myself in the caregiver/family member role. And while I “knew” how to take care of sick patients, being in the role of a caregiver to a family member was a huge learning curve for me.

I was not prepared! Losing my sense of control and moving to an observer/mediator role was tough. In a lot of instances my role was to serve as a translator between family and providers and finding needed resources for identified needs. This was a humbling experience going from being “in-charge” to sitting in a waiting room or at the bedside waiting for the next person who would enter the room, as well as trying to figure out how to make sure the people we needed were available. This was a period of true awakening for me on what the day-to-day struggles of being a cancer patient and/or caregiver really looked like.

This also taught me the importance of having essential representatives available or knowing when and how to reach out and find needed resources. Navigation or the lack thereof got real—resources and contacts for everything from keeping up with appointments, needed diagnostic scanning, side effect management at home, insurance coverage, home health, to hospice care. I still didn’t have a name in the forefront of my mind, but hmm…sounds like navigation.

I ultimately ended up working part-time in a healthcare facility on a medical oncology unit and was eventually asked to assume the role of nurse navigator for survivorship within Cancer Services! Guess what? I had no idea what a survivorship nurse navigator did, but at that time no one else knew either. This was during the time when patient navigation and survivorship became an accreditation standard for cancer programs. As systems struggled with what this would look like and how to integrate it into current program plans, I finally found out what I wanted to be when I grew up…an oncology nurse navigator!

Since that time, I have had to learn so much about the core skill set, complexities, and role delineation within the navigator’s role and then add survivorship to that. With my extensive background in general oncology and knowledge of the different cancers and their treatment modalities, I saw that adding patient navigation was a huge bonus. It was a natural fit for me. I am now able to take my past experiences and incorporate them into my role as an oncology survivorship nurse navigator, knowing and understanding that I serve as what I think of as a GPS for patients/caregivers before, during, and after a cancer experience. Hmm…this is navigation.

Understanding that my vision aligns with that of the Academy of Oncology Nurse & Patient Navigators by offering effective navigation, patient-centered superior quality cancer care coordination from prediagnosis through survivorship/end of life, I finally know who I am…an oncology survivorship nurse navigator.

I’m so grateful to live daily by the Navigator Pledge: As a navigator, I pledge my head to share knowledge and inform decision-making. My heart to empower advocacy and loyalty. My hands to deliver compassion and remove barriers. My hope to embrace and preserve quality of life.¹

Reference

1. Academy of Oncology Nurse & Patient Navigators. https://aonnonline.org/blog/takeaways-from-episode-4-of-the-heart-and-soul-of-oncology-navigation-podcast-professional-development-and-the-role-of-certification